This study evaluated how lesion location affects treatment response and prognosis in hepatocellular carcinoma (HCC) patients treated with lenvatinib (LEN) or immune checkpoint inhibitors (ICIs; atezolizumab/bevacizumab or durvalumab/tremelimumab). Considering tumor microenvironment and heterogeneity, we analyzed lesion-specific responses to optimize therapy.
Methods
In this retrospective study, lesion-specific responses were assessed for intrahepatic lesions (IHLs), lung, lymph node, intra-abdominal, and other lesions; bone metastases were excluded due to evaluation limitations. Responses were measured using a modified size-based RECIST 1.1 method. Lesion-specific objective response rate (ORR) and disease control rate (DCR) were compared between LEN and ICI groups.
Results
ORR for IHLs was higher with ICIs than LEN (16.3 % vs. 3.5 %, P = 0.002). No significant differences were observed for lung, lymph node, or intra-abdominal lesions; adrenal metastases showed no response in either group. Subgroup analysis indicated better ORR and DCR for lung lesions treated with ICIs and lymph node lesions treated with LEN in patients without IHLs versus those with IHLs.
Conclusions
ICIs achieved higher ORR in IHLs than LEN, with no significant differences for metastatic lesions. The presence of IHLs may influence distant lesion response, and therapeutic efficacy varies with treatment regimen.
背景：本研究评估病变位置如何影响lenvatinib （LEN）或免疫检查点抑制剂（ICIs； atezolizumab/bevacizumab或durvalumab/tremelimumab）治疗的肝细胞癌（HCC）患者的治疗反应和预后。考虑到肿瘤微环境和异质性，我们分析了病变特异性反应以优化治疗。方法：在这项回顾性研究中，评估了肝内病变（IHLs）、肺、淋巴结、腹腔内和其他病变的病变特异性反应；由于评估限制，排除骨转移。使用改进的基于大小的RECIST 1.1方法测量反应。比较LEN组和ICI组病变特异性客观缓解率（ORR）和疾病控制率（DCR）。结果：ICIs组ihl的ORR高于LEN组（16.3% vs. 3.5%, P = 0.002）。肺、淋巴结或腹腔内病变无显著差异；肾上腺转移在两组均无反应。亚组分析显示，与有IHLs的患者相比，无IHLs的患者使用ICIs治疗的肺部病变和使用LEN治疗的淋巴结病变的ORR和DCR更好。结论：ICIs在IHLs中的ORR高于LEN，在转移性病变中无显著差异。IHLs的存在可能影响远端病变反应，治疗效果随治疗方案的不同而不同。
{"title":"Impact of intrahepatic lesions on lesion-specific response rates in patients with hepatocellular carcinoma treated with lenvatinib or immune checkpoint inhibitors","authors":"Masaki Omori , Shohei Komatsu , Toshifumi Tada , Nobuaki Ishihara , Takanori Matsuura , Eisuke Ueshima , Yoshimi Fujishima , Jun Ishihda , Masahiro Kido , Hidetoshi Gon , Kenji Fukushima , Takeshi Urade , Hiroaki Yanagimoto , Keitaro Sofue , Yuzo Kodama , Takumi Fukumoto","doi":"10.1016/j.hpb.2025.11.008","DOIUrl":"10.1016/j.hpb.2025.11.008","url":null,"abstract":"<div><h3>Background</h3><div>This study evaluated how lesion location affects treatment response and prognosis in hepatocellular carcinoma (HCC) patients treated with lenvatinib (LEN) or immune checkpoint inhibitors (ICIs; atezolizumab/bevacizumab or durvalumab/tremelimumab). Considering tumor microenvironment and heterogeneity, we analyzed lesion-specific responses to optimize therapy.</div></div><div><h3>Methods</h3><div>In this retrospective study, lesion-specific responses were assessed for intrahepatic lesions (IHLs), lung, lymph node, intra-abdominal, and other lesions; bone metastases were excluded due to evaluation limitations. Responses were measured using a modified size-based RECIST 1.1 method. Lesion-specific objective response rate (ORR) and disease control rate (DCR) were compared between LEN and ICI groups.</div></div><div><h3>Results</h3><div>ORR for IHLs was higher with ICIs than LEN (16.3 % vs. 3.5 %, <em>P</em> = 0.002). No significant differences were observed for lung, lymph node, or intra-abdominal lesions; adrenal metastases showed no response in either group. Subgroup analysis indicated better ORR and DCR for lung lesions treated with ICIs and lymph node lesions treated with LEN in patients without IHLs versus those with IHLs.</div></div><div><h3>Conclusions</h3><div>ICIs achieved higher ORR in IHLs than LEN, with no significant differences for metastatic lesions. The presence of IHLs may influence distant lesion response, and therapeutic efficacy varies with treatment regimen.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 2","pages":"Pages 209-217"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145632711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-11-03DOI: 10.1016/j.hpb.2025.10.016
Saxon Connor
{"title":"A new perspective of the CVS in cholecystectomy","authors":"Saxon Connor","doi":"10.1016/j.hpb.2025.10.016","DOIUrl":"10.1016/j.hpb.2025.10.016","url":null,"abstract":"","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 2","pages":"Pages 154-156"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145540642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-11-27DOI: 10.1016/j.hpb.2025.11.013
Nicolas J. Smith, Simon D. Lai, John A. Windsor, Cameron I. Wells
Background
Completion cholecystectomy (CC) after subtotal cholecystectomy is being performed more often and can be a surgically challenging. This meta-analysis aimed to evaluate indications, techniques, and outcomes of CC.
Methods
A PRISMA-compliant systematic review of PubMed, MEDLINE, Embase, and CENTRAL (1995–2025). Random-effects models generated pooled estimates for the analysed outcomes.
Results
Forty-eight studies were identified (1225 patients). Common indications for CC were symptomatic cholelithiasis (55.8 %, 95 % CI: 45.6–70.8 %) and acute cholecystitis (19.8 %, 10.4–34.4 %). The interval from initial surgery to CC was 47 months (95 % CI: 36–58). Laparoscopy was the most frequent approach (75.6 %), with the open approach in 15.6 %. Symptom resolution was achieved in 92.5 % (95 % CI: 87.5–95.6 %) across a mean follow-up period of 595 days (95 % CI: 429–761). Overall complication rate was 14.0 % (95 % CI: 11.3–17.2 %). The rate of bile duct injury (BDI) was 2.0 % (95 % CI: 1.1–3.6 %). Sensitivity and subgroup analyses found no significant differences from the primary results.
Conclusion
Completion cholecystectomy is often feasible laparoscopically and is highly effective in relieving symptoms. The risk of complications and BDI remains high, and further research should focus on how to reduce the morbidity associated with CC.
{"title":"Completion cholecystectomy: a meta-analysis of indications, techniques and outcomes","authors":"Nicolas J. Smith, Simon D. Lai, John A. Windsor, Cameron I. Wells","doi":"10.1016/j.hpb.2025.11.013","DOIUrl":"10.1016/j.hpb.2025.11.013","url":null,"abstract":"<div><h3>Background</h3><div>Completion cholecystectomy (CC) after subtotal cholecystectomy is being performed more often and can be a surgically challenging. This meta-analysis aimed to evaluate indications, techniques, and outcomes of CC.</div></div><div><h3>Methods</h3><div>A PRISMA-compliant systematic review of PubMed, MEDLINE, Embase, and CENTRAL (1995–2025). Random-effects models generated pooled estimates for the analysed outcomes.</div></div><div><h3>Results</h3><div>Forty-eight studies were identified (1225 patients). Common indications for CC were symptomatic cholelithiasis (55.8 %, 95 % CI: 45.6–70.8 %) and acute cholecystitis (19.8 %, 10.4–34.4 %). The interval from initial surgery to CC was 47 months (95 % CI: 36–58). Laparoscopy was the most frequent approach (75.6 %), with the open approach in 15.6 %. Symptom resolution was achieved in 92.5 % (95 % CI: 87.5–95.6 %) across a mean follow-up period of 595 days (95 % CI: 429–761). Overall complication rate was 14.0 % (95 % CI: 11.3–17.2 %). The rate of bile duct injury (BDI) was 2.0 % (95 % CI: 1.1–3.6 %). Sensitivity and subgroup analyses found no significant differences from the primary results.</div></div><div><h3>Conclusion</h3><div>Completion cholecystectomy is often feasible laparoscopically and is highly effective in relieving symptoms. The risk of complications and BDI remains high, and further research should focus on how to reduce the morbidity associated with CC.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 2","pages":"Pages 143-153"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145714245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-11-22DOI: 10.1016/j.hpb.2025.11.012
Francisco Tustumi , Lucia Calthorpe , Nora Fotoohi , Thiago Costa Ribeiro , Lucas Cata Preta Stolzemburg , Andre L. Bettiati Junior , Caroline de Almeida Gonçalves , Ana P. Cursino Briet de Almeida , Allana M. Gomes Giordano , André Luís de Godoy , Dante Altenfelder , Julia Nicioli , Alexandre C. Guimarães , Alejandro S. Requejo , Alessandro Landskron Diniz , Alexandre Ferreira Oliveira , Alice C. Wei , André de Moricz , Andre L. Montagnini , Brendan C. Visser , Felipe José Fernández Coimbra
Background
Although minimally invasive surgery is widely accepted across surgical disciplines, its role in pancreatic cancer continues to be debated. The objective of the São Paulo Consensus on Minimally Invasive Pancreatic Surgery (MIPS) was to establish consensus statements on the use of MIPS for pancreatic cancer, integrating contemporary evidence and recent advances.
Methods
A scoping literature review informed statement development across five thematic groups: (1) Left Pancreatectomy for Pancreatic Cancer, (2) Pancreatoduodenectomy and Total Pancreatectomy for Pancreatic Cancer, (3) Neuroendocrine Pancreatic Tumors, (4) Patient Evaluation and Surgical Technique, and (5) Implementation, Training, and Innovation. A three-round modified Delphi process was conducted with an international panel of 52 expert pancreas surgeons. Consensus was defined as ≥90 % agreement.
Results
From 2590 publications, 185 studies were selected for inclusion. Fifty-two hepatopancreatobiliary surgeons, with a median of 22 years of experience, achieved consensus through a three-round Delphi process. Ultimately, 22 of the initial 28 statements met the ≥90 % agreement threshold. The resulting recommendations provide evidence-based guidance on minimally invasive pancreas resection for cancer, including neuroendocrine tumors, patient evaluation, program implementation, and innovation.
Discussion
The São Paulo Consensus provides contemporary, evidence-based recommendations to guide the safe and judicious adoption, implementation, and practice of minimally invasive techniques.
{"title":"The São Paulo International Consensus on Minimally Invasive Pancreatic Surgery for Cancer","authors":"Francisco Tustumi , Lucia Calthorpe , Nora Fotoohi , Thiago Costa Ribeiro , Lucas Cata Preta Stolzemburg , Andre L. Bettiati Junior , Caroline de Almeida Gonçalves , Ana P. Cursino Briet de Almeida , Allana M. Gomes Giordano , André Luís de Godoy , Dante Altenfelder , Julia Nicioli , Alexandre C. Guimarães , Alejandro S. Requejo , Alessandro Landskron Diniz , Alexandre Ferreira Oliveira , Alice C. Wei , André de Moricz , Andre L. Montagnini , Brendan C. Visser , Felipe José Fernández Coimbra","doi":"10.1016/j.hpb.2025.11.012","DOIUrl":"10.1016/j.hpb.2025.11.012","url":null,"abstract":"<div><h3>Background</h3><div>Although minimally invasive surgery is widely accepted across surgical disciplines, its role in pancreatic cancer continues to be debated. The objective of the São Paulo Consensus on Minimally Invasive Pancreatic Surgery (MIPS) was to establish consensus statements on the use of MIPS for pancreatic cancer, integrating contemporary evidence and recent advances.</div></div><div><h3>Methods</h3><div>A scoping literature review informed statement development across five thematic groups: (1) Left Pancreatectomy for Pancreatic Cancer, (2) Pancreatoduodenectomy and Total Pancreatectomy for Pancreatic Cancer, (3) Neuroendocrine Pancreatic Tumors, (4) Patient Evaluation and Surgical Technique, and (5) Implementation, Training, and Innovation. A three-round modified Delphi process was conducted with an international panel of 52 expert pancreas surgeons. Consensus was defined as ≥90 % agreement.</div></div><div><h3>Results</h3><div>From 2590 publications, 185 studies were selected for inclusion. Fifty-two hepatopancreatobiliary surgeons, with a median of 22 years of experience, achieved consensus through a three-round Delphi process. Ultimately, 22 of the initial 28 statements met the ≥90 % agreement threshold. The resulting recommendations provide evidence-based guidance on minimally invasive pancreas resection for cancer, including neuroendocrine tumors, patient evaluation, program implementation, and innovation.</div></div><div><h3>Discussion</h3><div>The São Paulo Consensus provides contemporary, evidence-based recommendations to guide the safe and judicious adoption, implementation, and practice of minimally invasive techniques.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 2","pages":"Pages 105-118"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145793754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-11-07DOI: 10.1016/j.hpb.2025.11.001
Ethan S. Agritelley , Julia Button , Matthew Bao , Elishama N. Kanu , Ryne C. Ramaker , Peter J. Allen , Daniel P. Nussbaum
{"title":"Comparing traditional versus total neoadjuvant chemotherapy for patients with localized pancreatic cancer","authors":"Ethan S. Agritelley , Julia Button , Matthew Bao , Elishama N. Kanu , Ryne C. Ramaker , Peter J. Allen , Daniel P. Nussbaum","doi":"10.1016/j.hpb.2025.11.001","DOIUrl":"10.1016/j.hpb.2025.11.001","url":null,"abstract":"","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 2","pages":"Pages 245-249"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145587177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2026-02-12DOI: 10.1016/S1365-182X(26)00021-3
{"title":"Highlights in this issue","authors":"","doi":"10.1016/S1365-182X(26)00021-3","DOIUrl":"10.1016/S1365-182X(26)00021-3","url":null,"abstract":"","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 2","pages":"Page iii"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146192995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-11-20DOI: 10.1016/j.hpb.2025.11.010
Sarah L. Yager, Akin Erol, Linda L. Wong
Background
Hepatocellular carcinoma (HCC) treatment is evolving rapidly with systemic/locoregional therapies which increase surgical options. This study explores whether neoadjuvant therapies affect early surgical outcomes.
Methods
National Surgical Quality Improvement Program (NSQIP) database was used to identify patients who underwent major hepatectomy for HCC from 2020 to 2023. We defined two groups; upfront hepatectomy and neoadjuvant therapy. Patient characteristics, preoperative and intraoperative factors, and postoperative outcomes were analyzed.
Results
Of 837 patients, 673 (80.4 %) had upfront hepatectomy, 164 (19.6 %) had neoadjuvant therapy. Neoadjuvant therapy patients were more likely to have preoperative albumin <3.5 gm/dL (23.1 vs 13.8 %, p = 0.004), pre-operative platelet count <150 103/jL (17.2 vs 10.6 %, p = 0.016), transfusions (36.6 vs 23.2 %, p < 0.001), biliary reconstruction (9.8 vs 5.5 %, p = 0.04) and operative time >300 min (51.2 vs 34.7 %, p < 0.001). Length of stay and 30-day mortality were similar. Multivariate analysis showed intraarterial therapy and hepatitis B were more predictive of developing grade B/C liver failure.
Conclusions
While neoadjuvant therapy for HCC may increase surgical candidacy, patients may be sicker at resection and cases may be more challenging. Although early mortality is similar, neoadjuvant therapy may potentially affect liver function. More studies are needed to optimally select patients for conversion therapy.
背景：肝细胞癌（HCC）的治疗正在迅速发展，全身/局部治疗增加了手术选择。本研究探讨新辅助治疗是否会影响早期手术结果。方法：使用国家手术质量改进计划（NSQIP）数据库，识别2020年至2023年因HCC接受大肝切除术的患者。我们定义了两组；前期肝切除术和新辅助治疗。分析患者特点、术前、术中因素及术后结果。结果：837例患者中，673例（80.4%）行前期肝切除术，164例（19.6%）行新辅助治疗。新辅助治疗患者术前白蛋白3/jL （17.2 vs 10.6%, p = 0.016）、输血（36.6 vs 23.2%, p < 0.001）、胆道重建（9.8 vs 5.5%, p = 0.04）和手术时间bb0 300 min （51.2 vs 34.7%, p < 0.001）的可能性更大。住院时间和30天死亡率相似。多因素分析显示，动脉内治疗和乙型肝炎更能预测发生B/C级肝衰竭。结论：虽然肝细胞癌的新辅助治疗可能增加手术的可能性，但患者在切除时病情可能更重，病例可能更具挑战性。虽然早期死亡率相似，但新辅助治疗可能会影响肝功能。需要更多的研究来最佳地选择患者进行转化治疗。
{"title":"The impact of neoadjuvant therapy on postoperative outcomes in patients undergoing hepatectomies for hepatocellular carcinoma","authors":"Sarah L. Yager, Akin Erol, Linda L. Wong","doi":"10.1016/j.hpb.2025.11.010","DOIUrl":"10.1016/j.hpb.2025.11.010","url":null,"abstract":"<div><h3>Background</h3><div>Hepatocellular carcinoma (HCC) treatment is evolving rapidly with systemic/locoregional therapies which increase surgical options. This study explores whether neoadjuvant therapies affect early surgical outcomes.</div></div><div><h3>Methods</h3><div>National Surgical Quality Improvement Program (NSQIP) database was used to identify patients who underwent major hepatectomy for HCC from 2020 to 2023. We defined two groups; upfront hepatectomy and neoadjuvant therapy. Patient characteristics, preoperative and intraoperative factors, and postoperative outcomes were analyzed.</div></div><div><h3>Results</h3><div>Of 837 patients, 673 (80.4 %) had upfront hepatectomy, 164 (19.6 %) had neoadjuvant therapy. Neoadjuvant therapy patients were more likely to have preoperative albumin <3.5 gm/dL (23.1 vs 13.8 %, p = 0.004), pre-operative platelet count <150 10<sup>3</sup>/jL (17.2 vs 10.6 %, p = 0.016), transfusions (36.6 vs 23.2 %, p < 0.001), biliary reconstruction (9.8 vs 5.5 %, p = 0.04) and operative time >300 min (51.2 vs 34.7 %, p < 0.001). Length of stay and 30-day mortality were similar. Multivariate analysis showed intraarterial therapy and hepatitis B were more predictive of developing grade B/C liver failure.</div></div><div><h3>Conclusions</h3><div>While neoadjuvant therapy for HCC may increase surgical candidacy, patients may be sicker at resection and cases may be more challenging. Although early mortality is similar, neoadjuvant therapy may potentially affect liver function. More studies are needed to optimally select patients for conversion therapy.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 2","pages":"Pages 218-224"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145695930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2026-01-01DOI: 10.1016/j.hpb.2025.12.004
Tung Hoang , Hyeree Park , Youngmin Han , Jin-Young Jang , Aesun Shin , Hojoon Sohn
Background
High-resolution imaging techniques are recommended for screening and surveillance of pancreatic cystic neoplasms (PCNs). This study aimed to systematically review current evidence on the economic aspects of PCN management.
Methods
Original studies published up to November 2023 were identified from PubMed, Embase, and Cochrane databases. Included studies conducted economic evaluations or modeled the natural history of pancreatic diseases. Data on costs, effectiveness, and model parameters were extracted.
Results
A total of 33 studies were eligible for this review. Of 26 model-based studies, only three included histopathological features of pancreatic ductal adenocarcinoma (PDAC), and five incorporated different cancer stages. Compared to no screening or surveillance, the IAP 2006 guideline was cost-effective ($26,158/QALY), whereas IAP 2017 was not ($180,395/QALY). Using imaging modalities (computed tomography, magnetic resonance imaging, and endoscopic ultrasound) was more cost-effective than the full-watching strategy in populations of high-risk pancreatic cancer (e.g., 3-year PDAC risk of at least 1 %, familial or hereditary diseases, or new onset diabetes). In contrast, immediate resection-based strategies were not cost-effective at the level of willingness-to-pay of $100,000.
Conclusion
Cost-effectiveness findings varied significantly depending on PCN type, surveillance strategy, and model structure. Standardized approaches to modeling and reporting are needed.
{"title":"A systematic review of economic evaluation in pancreatic cystic neoplasms","authors":"Tung Hoang , Hyeree Park , Youngmin Han , Jin-Young Jang , Aesun Shin , Hojoon Sohn","doi":"10.1016/j.hpb.2025.12.004","DOIUrl":"10.1016/j.hpb.2025.12.004","url":null,"abstract":"<div><h3>Background</h3><div>High-resolution imaging techniques are recommended for screening and surveillance of pancreatic cystic neoplasms (PCNs). This study aimed to systematically review current evidence on the economic aspects of PCN management.</div></div><div><h3>Methods</h3><div>Original studies published up to November 2023 were identified from PubMed, Embase, and Cochrane databases. Included studies conducted economic evaluations or modeled the natural history of pancreatic diseases. Data on costs, effectiveness, and model parameters were extracted.</div></div><div><h3>Results</h3><div>A total of 33 studies were eligible for this review. Of 26 model-based studies, only three included histopathological features of pancreatic ductal adenocarcinoma (PDAC), and five incorporated different cancer stages. Compared to no screening or surveillance, the IAP 2006 guideline was cost-effective ($26,158/QALY), whereas IAP 2017 was not ($180,395/QALY). Using imaging modalities (computed tomography, magnetic resonance imaging, and endoscopic ultrasound) was more cost-effective than the full-watching strategy in populations of high-risk pancreatic cancer (e.g., 3-year PDAC risk of at least 1 %, familial or hereditary diseases, or new onset diabetes). In contrast, immediate resection-based strategies were not cost-effective at the level of willingness-to-pay of $100,000.</div></div><div><h3>Conclusion</h3><div>Cost-effectiveness findings varied significantly depending on PCN type, surveillance strategy, and model structure. Standardized approaches to modeling and reporting are needed.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 2","pages":"Pages 119-132"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145889200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-11-19DOI: 10.1016/j.hpb.2025.11.007
Kate Couzens-Bohlin , Sanju Sobnach , Jake Krige , Urda Kotze , Christo Kloppers , Marc Bernon , Stefano Cacciatore , Eduard Jonas
Background
Hepatic cystic echinococcosis (HCE) appears more severe in human immunodeficiency virus (HIV) co-infected (HIV+) patients with a more complicated clinical presentation (larger, multifocal cysts, biliary obstruction, secondary infection, cyst rupture), often necessitating urgent treatment with higher post-operative complications. This case-cohort study compared HCE treatment outcomes in HIV+ and HIV negative (HIV-) patients.
Methods
Patients with known HIV status who underwent HCE surgery at our tertiary institution between 2011 and 2023 were assessed for pre-, intra-, and post-operative outcomes. Surgical complications were compared using the Accordion severity scores.
Results
The majority of the 87 operated patients were HIV+ (51.7 %). Complication rates were comparable between the HIV+ and HIV- groups with similar Accordion severity scores. Cholangitis was statistically less frequent in HIV+ (6.7 %) vs. HIV- patients (26.2 %), p = 0.019. Cyst infection rates were lower in HIV+ (20.0 %) than in HIV- (38.1 %) patients. Five HIV+ and three HIV- patients required re-operation. Mortality occurred in two HIV+ and five HIV- patients.
Conclusion
Although outcomes were similar, the disproportionately high number of HIV+ patients (51.7 %) compared to the general population HIV prevalence (12.7 %) suggests that HCE is less self-limiting with HIV co-infection, supporting a potential link between co-infection and severity of disease presentation.
{"title":"Surgical treatment outcomes of hepatic cystic echinococcosis in HIV-positive and HIV-negative patients: a South African cohort study","authors":"Kate Couzens-Bohlin , Sanju Sobnach , Jake Krige , Urda Kotze , Christo Kloppers , Marc Bernon , Stefano Cacciatore , Eduard Jonas","doi":"10.1016/j.hpb.2025.11.007","DOIUrl":"10.1016/j.hpb.2025.11.007","url":null,"abstract":"<div><h3>Background</h3><div>Hepatic cystic echinococcosis (HCE) appears more severe in human immunodeficiency virus (HIV) co-infected (HIV+) patients with a more complicated clinical presentation (larger, multifocal cysts, biliary obstruction, secondary infection, cyst rupture), often necessitating urgent treatment with higher post-operative complications. This case-cohort study compared HCE treatment outcomes in HIV+ and HIV negative (HIV-) patients.</div></div><div><h3>Methods</h3><div>Patients with known HIV status who underwent HCE surgery at our tertiary institution between 2011 and 2023 were assessed for pre-, intra-, and post-operative outcomes. Surgical complications were compared using the Accordion severity scores.</div></div><div><h3>Results</h3><div>The majority of the 87 operated patients were HIV+ (51.7 %). Complication rates were comparable between the HIV+ and HIV- groups with similar Accordion severity scores. Cholangitis was statistically less frequent in HIV+ (6.7 %) vs. HIV- patients (26.2 %), p = 0.019. Cyst infection rates were lower in HIV+ (20.0 %) than in HIV- (38.1 %) patients. Five HIV+ and three HIV- patients required re-operation. Mortality occurred in two HIV+ and five HIV- patients.</div></div><div><h3>Conclusion</h3><div>Although outcomes were similar, the disproportionately high number of HIV+ patients (51.7 %) compared to the general population HIV prevalence (12.7 %) suggests that HCE is less self-limiting with HIV co-infection, supporting a potential link between co-infection and severity of disease presentation.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 2","pages":"Pages 199-208"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145677534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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